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Vertebral artery dolichoectasia leading to hemifacial spasm

Menachem Gold1
,  
George El Hasbani2  
,  
Richard Assaker3
,  
Jose Francisco Vargas3
,  
Munir H. Idriss3
,  
Kamal Tarabine4
,  
Alexander Rabinovich5

1 Lincoln Medical and Mental Health Center, Department of Radiology, Weill Cornell Medical Center, Bronx, New York, United States

2 American University of Beirut Medical Center, Department of Dermatology, Beirut, Lebanon

3 Lincoln Medical and Mental Health Center, Department of Internal Medicine, Bronx, New York, United States

4 Lebanese American University Medical Center , Department of Radiology, Beirut, Lebanon

5 Lincoln Medical and Mental Health Center, Department of Ophthalmology, The Mount Sinai Hospital, Bronx, United States

Address correspondence to:

George El Hasbani

MD, American University of Beirut Medical Center, Department of Dermatology, Research Assistant,

Lebanon

Message to Corresponding Author


Article ID: 101015Z01MG2019

doi: 10.5348/101015Z01MG2019CL

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How to cite this article

Gold M, El Hasbani G, Assaker R, Vargas JF, Idriss MH, Tarabine K, Rabinovich A. Vertebral artery dolichoectasia leading to hemifacial spasm. Int J Case Rep Images 2019;10:101015Z01MG2019.

ABSTRACT

No Abstract

Keywords: Facial nerve, Hemifacial spasm, Vertebrobasilar dolichoectasia

Case Report

A 45-year-old male presented to the ophthalmology clinic complaining of constant twitching in the left face for three years, associated with a moderate left temporal headache. He was noted to have tonic-clonic contractions of the left orbicularis oculi and oris muscles (Figure 1, Video 1). MR imaging through the posterior fossa (Figure 2) demonstrated compression of the pons at the facial nerve root entry zone by an ectatic left vertebral artery. The patient’s symptoms improved with botulinum neurotoxin injections. The most common etiology of hemifacial spasm is compression of the facial nerve as it emerges from the brainstem by ectatic vessels.

Figure 1: Patient had tonic-clonic contractions of the left orbicularis oculi and oris muscles

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Video 1: Hemifacial spasm involving the left orbicularis oris and orbicularis oculi muscles.

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Figure 2: (A, B): MR imaging through the posterior fossa demonstrated compression of the pons at the facial nerve root entry zone by an ectatic left vertebral artery.

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Discussion

Vertebrobasilar dolichoectasia is a rare dilative arteriopathy defined as elongation or widening of the intracranial vertebral and/or basilar arteries [1]. Hemifacial spasm (HFS) involves involuntary and painless spasms of the muscles supplied by the facial nerve starting with spasm of the orbicularis muscle and then progressing to involve all the facial muscles [2]. Although the compression of the facial nerve can be caused by tumors or bony abnormalities, compression by a blood vessel is the most common [2]. The diagnosis of HFS due to VAD necessitates imaging techniques whereby magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are the optimal imaging techniques for demonstrating the compression [3]. The two most commonly reported treatments for hemifacial spasm in the literature are botulinum toxin injections and surgical microvascular decompression. Botulinum toxin injection is clinically successful for long term management with low incidence of adverse effects [4]. It has been usually used as a first line treatment [5]. In our case, few Botox injections helped alleviate the patient’s symptoms for a prolonged period. Surgical microvascular decompression is the permanent treatment option. However, a small chance of serious complications do exist such as deafness, severe facial paralysis, cerebellar hematoma, brain stem infarct, and very rarely death [6].

Conclusion

Vertebrobasilar dolichoectasia (VBS) can rarely compress the facial nerve at the root leading to hemifacial spasm. The diagnosis necessitates the use of MRI or MRA. Treating with Botox injections have been effective. Although surgical microvascular decompression is the permanent treatment option, several serious side effects have been reported.

REFERENCES

1.

Vanikieti K, Cheecharoen P, Jindahra P, Lueangaram S, Padungkiatsagul T. Atypical oculopalatal tremor as the presentation of vertebral artery dolichoectasia. Int Med Case Rep J 2016;9:273–7. [CrossRef] [Pubmed]   Back to citation no. 1  

2.

Rahman EA, Trobe JD, Gebarski SS. Hemifacial spasm caused by vertebral artery dolichoectasia. Am J Ophthalmol 2002;133(6):854–6. [CrossRef] [Pubmed]   Back to citation no. 1  

3.

Yaltho TC, Jankovic J. The many faces of hemifacial spasm: Differential diagnosis of unilateral facial spasms. Mov Disord 2011;26(9):1582–92. [CrossRef] [Pubmed]   Back to citation no. 1  

4.

Czyz CN, Burns JA, Petrie TP, Watkins JR, Cahill KV, Foster JA. Long-term botulinum toxin treatment of benign essential blepharospasm, hemifacial spasm, and Meige syndrome. Am J Ophthalmol 2013;156(1):173–7.e2. [CrossRef] [Pubmed]   Back to citation no. 1  

5.

Wang X, Thirumala PD, Shah A, et al. Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm. Neurosurg Focus 2013;34(3):E3. [CrossRef] [Pubmed]   Back to citation no. 1  

6.

Qi H, Zhang W, Zhang X, Zhao C. Microvascular decompression surgery for hemifacial spasm. J Craniofac Surg 2016;27(1):124–7. [CrossRef] [Pubmed]   Back to citation no. 1  

SUPPORTING INFORMATION

Author Contributions

Menachem Gold - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

George El Hasbani - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Richard Assaker - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Jose Francisco Vargas - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Munir H. Idriss - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Kamal Tarabine - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Alexander Rabinovich - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Guaranter of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this clinical image.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Open Access Statement

All relevant data are within the paper and its Supporting Information files.

Copyright

© 2019 Menachem Gold et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


Comment on Article

Lumbar Spondylolysis
Malignant soft tissue tumor, wide excision, and sural flap
Knife swallowing ended up with esophagectomy